Patterns of presentation in postpartum pituitary necrosis (Sheehan syndrome)

Abstract

Sheehan syndrome classically presents with hypopituitarism after postpartum hemorrhage. Although prevalence of Sheehan syndrome has decreased, it continues to be a common cause of hypopituitarism in developing countries. Disease classically presents with postpartum bleeding and a combination of anterior and posterior pituitary hormone deficiencies, although involvement of posterior pituitary is rare. Atypical presentation like cardiac or renal involvement, anemia and psychosis are not uncommon. Prevention and aggressive management of bleeding at the time of delivery largely prevents pituitary damage. 

Until 1938 the disease, postpartum pituitary necrosis was known as Simmond’s disease. Women dying after severe postpartum bleeding had extensive anterior pituitary necrosis on autopsy. Due to thrombosis or bacterial emboli in hypophyseal arteries. 1 Sheehan then stated that Simmond’s disease was due to necrosis of anterior pituitary following post partum hemorrhage. 2 Normally pituitary gland enlarges during pregnancy 3 under the influence of placental hormones mainly estrogen. The enlargement of pituitary results in compression of small hypophyseal arteries and in presence of PPH causes necrosis of the gland. 3,4 In addition to PPH, pituitary autoimmunity and coagulation disturbances are believed to be risk factors for development of SS. 5,6 Rarely Sheehan syndrome (SS) can run in multiple generations.